Acne

Acne is a common skin disease that causes pimples. Pimples form when hair follicles under your skin clog up. Most pimples form on the face, neck, back, chest, and shoulders. Anyone can get acne, but it is common in teenagers and young adults. It is not serious, but it can cause scars.

No one knows exactly what causes acne. Hormone changes, such as those during the teenage years and pregnancy, probably play a role. There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and pimples are not caused by dirt. Stress doesn’t cause acne, but stress can make it worse.

IF YOU HAVE ACNE

• Clean your skin gently
• Try not to touch your skin
• Avoid the sun

Treatments for acne include medicines and creams.

Risk Factors

People of all races and ages get acne. It is most common in adolescents and young adults. An estimated 80 percent of all people between the ages of 11 and 30 have acne outbreaks at some point. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have this skin problem.

Causes

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is an increase in hormones called androgens (male sex hormones). These increase in both boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne.

Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder. Certain drugs, including androgens and lithium, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together, producing a plug.

FACTORS THAT CAN MAKE ACNE WORSE

Factors that can cause an acne flare include:

• Changing hormone levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts
• Oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats)
• Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms
• Environmental irritants, such as pollution and high humidity
• Squeezing or picking at blemishes
• Hard scrubbing of the skin
• Stress.

MYTHS ABOUT THE CAUSES OF ACNE

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but there is little evidence that foods have much effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt. Stress doesn’t cause acne, but research suggests that for people who have acne, stress can make it worse.

Symptoms

People with acne frequently have a variety of lesions. The basic acne lesion, called the comedo, is simply an enlarged and plugged hair follicle. If the comedo stays beneath the skin, it is called a closed comedo and produces a white bump called a whitehead. A comedo that reaches the surface of the skin and opens up is called an open comedo or blackhead because it looks black on the skin’s surface. This black discoloration is due to changes in sebum as it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

OTHER TROUBLESOME ACNE LESIONS CAN DEVELOP, INCLUDING THE FOLLOWING:

• Papules. Inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch.
• Pustules (pimples). Papules topped by white or yellow pus-filled lesions that may be red at the base.
• Nodules. Large, painful, solid lesions that are lodged deep within the skin.
• Cysts. Deep, painful, pus-filled lesions that can cause scarring.

Treatment

Acne is often treated by dermatologists, who are doctors who specialize in skin problems. These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

TREATMENT FOR BLACKHEADS, WHITEHEADS, AND MILD INFLAMMATORY ACNE

Doctors usually recommend an OTC or prescription topical medicine for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

Following are some of the most common OTC topical medicines:

• Benzoyl peroxide. Kills P. acnes, and may also reduce oil production
• Resorcinol. Can help break down blackheads and whiteheads
• Salicylic acid. Helps break down blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicles
• Sulfur. Helps break down blackheads and whiteheads.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. OTC topical medicines are somewhat effective in treating acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement.

TREATMENT FOR MODERATE-TO-SEVERE INFLAMMATORY ACNE

People with moderate-to-severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Several types of prescription topical medicines are used to treat acne. They include:

• Antibiotics. Help stop or slow the growth of bacteria and reduce inflammation
• Vitamin A derivatives (retinoids). Unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones.

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects including stinging, burning, redness, peeling, scaling, or discoloration of the skin.

For patients with moderate-to-severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

TREATMENT FOR SEVERE NODULAR OR CYSTIC ACNE

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin, a retinoid. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

TREATMENTS FOR HORMONALLY INFLUENCED ACNE IN WOMEN

In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens.

The doctor may prescribe one of several drugs to treat women with this type of acne:

• Birth control pills. To help suppress the androgen produced by the ovaries
• Low-dose corticosteroid drugs, such as prednisone or dexamethasone. To help suppress the androgen produced by the adrenal glands
• Antiandrogen drugs such as spironolactone. To reduce the excessive oil production.

OTHER TREATMENTS FOR ACNE

Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient’s comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of “sanding down” scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.

Recovery

Clean Skin Gently

If you have acne, you should gently wash your face with a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Wash your face from under the jaw to the hairline and be sure to thoroughly rinse your skin.

Using strong soaps or rough scrub pads is not helpful and can actually make the problem worse. Astringents are not recommended unless the skin is very oily, and then they should be used only on oily spots.

AVOID FREQUENT HANDLING OF THE SKIN

Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark blotches.

SHAVE CAREFULLY

Test both electric and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften the hair thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the risk of nicking blemishes.

AVOID A SUNBURN OR SUNTAN

Many of the medicines used to treat acne can make you more prone to sunburn. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

CHOOSE COSMETICS CAREFULLY

While undergoing acne treatment, you may need to change some of the cosmetics you use. All cosmetics and hair-care products should be oil free. Choose products labeled noncomedogenic (meaning they don’t promote the formation of closed pores). In some people, however, even these products may make acne worse.